The DMA-6 is the form Georgia Medicaid uses to record a physician’s judgment that a person needs the care a nursing facility provides. Its printed title is “Physician’s Recommendation Concerning Nursing Facility Care or Intermediate Care for the Intellectually Disabled”. Admissions coordinators, hospital discharge planners, physician offices and waiver case managers all handle it, and most of what circulates about it is out of date. This is the form as the state’s own manuals describe it in the October 2026 editions.
Where to get the form
The Department of Community Health publishes the DMA-6 on the GAMMIS Forms page, listed as “DMA-6: Physician Recommendation Nursing/Intermediate Care”. The copy there carries the footer “DMA-6 (Revised 08/11/2021)”. The Nursing Facility Services manual gives the same route: “Copies of the DMA-6 may be obtained by ordering or downloading”.
Two cautions. The direct link to the PDF changes whenever the state re-uploads the file, so bookmark the Forms page, not the file. And more than one revision is in circulation: the Independent Care Waiver manual embeds its own variant with the footer “DMA-6 (Revised 2/26/2026)”, and the nursing facility manual’s instructions still refer to a 1991 revision. Use the copy your program’s manual points to.
Which programs use the DMA-6, and which do not
| Program | Instrument | Who reviews it |
|---|---|---|
| Nursing facility admission, age 19 and over | DMA-6, with the DMA-613 (PASRR Level I) | Nobody precertifies the DMA-6; the contractor reviews the DMA-613 |
| Nursing facility admission, 18 and under | DMA-6A, the pediatric form | Same |
| Swing bed | DMA-6 | Alliant Health Solutions, by web |
| Independent Care Waiver Program (ICWP) | DMA-6, the ICWP variant | Alliant Health Solutions |
| NOW and COMP | DMA-6 or DMA-6A at first, the DMA-7 for re-evaluations | The DBHDD Field Office |
| Katie Beckett (TEFRA) | DMA-6A, with the Medical Necessity/Level of Care Statement | Alliant Health Solutions |
| Georgia Pediatric Program (GAPP) | DMA-6A, entered electronically by the nursing agency | Alliant Health Solutions |
| Elderly and Disabled Waiver Program (CCSP and SOURCE) | Not the DMA-6. Form 5588 | Alliant validates; the RN care coordinator certifies |
| Hospice | Not the DMA-6. The Hospice Care Communicator |
The row that surprises people is the Elderly and Disabled Waiver. CCSP and SOURCE do not run on the DMA-6. Their instrument is Form 5588, titled “Elderly and Disabled Waiver Services Program Level of Care and Placement Instrument”, and the DMA-6 enters only when a member leaves the waiver for a facility: the case management manual has case managers assist “clients in obtaining a DMA-6 Form when they plan to enter a nursing facility”. The two forms are covered side by side below.
What the form asks for
The DMA-6 has three sections, and three different people fill them in.
Section A, identifying information. The facility’s job: “It is the responsibility of the facility to see that Section A of the form is completed.” It covers the applicant, the type of facility, where the person is transferring from, and a release that the patient, spouse, relative or legal representative signs so the facility and physician can share “necessary information including Medical Data” with the state.
Section B, the physician’s report and recommendation. The diagnoses on admission with ICD-10 codes; the treatment plan, including hospital dates and hospital diagnoses, every medication with dosage, route and frequency, and procedures; the level of care recommended; how long care is needed; and whether the condition “could” or “could not be managed by provisions of community care or home health services”. Then the certification, which on the current form reads: “I certify that the patient requires the level of care provide by a nursing facility or an Intermediate care facility for the intellectually disabled.” The typo is the form’s.
Section C, the evaluation of nursing care needed. “All items in Section C of this form must be completed by licensed personnel involved in the care of this patient.” Diet, bowel and bladder, mental and behavioral status, skin, therapies by weekly frequency, and two scored legends: impairments (sight, hearing, speech, motion, paralysis) and activities of daily living (eating, transfer, bathing, ambulation, dressing).
Everything below “DO NOT WRITE BELOW THIS LINE” belongs to the reviewer.
Who signs, and how old the signature can be
For a nursing facility admission the manual says the form is “signed by the admitting physician”, and adds: “The physician must sign the form. Signature stamps are not acceptable”. The nursing facility and swing bed manuals say “physician” and nothing wider. Other programs do go wider, in their own words: the ICWP manual accepts a DMA-6 “signed and dated by the physician, physician assistant, or nurse practitioner”, and the NOW and COMP manual names the same three. Do not carry one program’s rule into another.
The signature has a shelf life of thirty days for a nursing facility, and the manual states it three ways: it “must not exceed thirty (30) days prior to the DMA-613 pre-authorization”; it must be “dated no more than thirty (30) days before the date of admission”; and it must be “dated no more than thirty (30) days before the date of evaluation by the Contractor”. A form signed within thirty days of all three is safe under any reading.
Other programs run their own clocks:
- ICWP. “A DMA-6 is approved for no more than 12 months”, and “the signature date should be within 90 days of the start date of service”.
- Swing bed. “The approval is effective for a period of thirty (30) days”, and each recertification takes a new DMA-6.
- Katie Beckett. The DMA-6A is “valid for a period of 90 days from the signature date”.
- NOW and COMP. “LOC service approval may not exceed 365 days.”
The nursing facility DMA-6 is not sent anywhere
This is the most common misunderstanding. Since April 1, 2003, “Nursing Facilities are no longer required to make contact with the Contractor for precertification of the DMA-6.” The form “must be kept in the resident’s file in the nursing facility”, and DFCS does not get a copy: “The DMA-6 is no longer sent to DFCS/LTCU.” What the county office receives for a nursing home resident is a different form, the DMA-59.
That does not make the DMA-6 a formality. The manual calls it “the only document that determines a level of care approval”. The risk moved from a returned form to an audit: the file either holds a DMA-6 that was complete and signed in time, or the facility was paid for days it cannot support.
A nursing facility level of care does not expire on a date. “All admissions will be considered permanent until the resident no longer meets a nursing facility level of care.” The yearly step is not a new DMA-6; the facility must “provide an annual Physician Attestation Statement”. A new DMA-6 is needed when a resident is discharged without an anticipated return and comes back, when “the admission process starts over with a new DMA-6 and a new DMA-59”, and on transfer, when “the admitting facility must secure a valid DMA-6”. A return from the hospital with an anticipated return does not need one.
The DMA-6 and the PASRR Level I
People search for a “DMA-6 Level 1 form”. No form has that name. What they are most likely looking for is the form that travels with the DMA-6 into a nursing facility: the DMA-613, the “PASRR Level I Application Resident Identification Screening Instrument”. The manual pairs them in one sentence: “The DMA-6 or P6A and the DMA-613 are the forms that are required for nursing facility admission.”
The order matters. The DMA-6 “must be completed in its entirety and signed by a physician, prior to completion of the Form DMA-613”. The facility submits the DMA-613 online for screening and prior authorization; “the physician does not need to sign the DMA-613”. The authorization code that comes back is written on the DMA-6 itself, in field 9A or 9B, which is printed “State Authority (MH & ID Screening) Level I/II”. The screening applies “regardless of payment source”, and the authorization “must not exceed sixty (60) days prior to the facility’s admission of a resident”. Admit before the code is issued and the state denies payment for the days before it.
Form 5588, the EDWP instrument
A case manager in CCSP or SOURCE works with Form 5588. It reads like a cousin of the DMA-6: a release, diagnoses, medications, the same impairment and daily-living legends, the same “could / could not be managed” question, and a certification that the patient “requires / does not require the intermediate level of care provided by EDWP or a nursing facility”. It also does a second job the DMA-6 does not: “the LOC page represents the physician’s order for all waivered services”.
Three things differ in practice. Signers are wider: “MD, DO, RNP or PA must sign form 5588.” It is reviewed before the physician sees it: the nurse uploads the assessment to Alliant for validation, the 5588 then goes to the physician, and the RN care coordinator signs “within twenty-four hours or no later than the following business day” after it comes back. And it runs on a year: the length of stay is “not to exceed a maximum of 365 days”, with re-evaluation starting “at least three months prior to the expiration”. DFCS follows up if “the LOC form is not sent to DFCS within 30 days of the application date”.
The unsigned form has a price. In the manual’s words, utilization review “will recover payments made to the provider if there is no physician/RNP/PA signature.”
What has to be behind the signature
On either form the physician is certifying a history, and much of it was written somewhere else. Section B of the DMA-6 asks for hospital dates and hospital diagnoses and every current medication, and allows that a “hospital transfer report may be attached”. For the Elderly and Disabled Waiver, the packet uploaded to Alliant includes “Physician or the agency’s Medical Director medical records documentation”. For ICWP, “AHS may request medical records to determine the level of care”, and the manual’s list of reasons a case stalls includes the member who “fails to visit physician and obtain his/her signature on DMA-6” and the case where “the physician refuses to sign the DMA-6 until s/he sees the member”.
That last line is the whole problem in one sentence. A physician asked to certify a nursing facility level of care for someone admitted twice this year, with a specialist they have never spoken to, is being asked to sign for what a hospital and another practice found. If the chart in front of them does not show it, the form waits, and the thirty days, the ninety days or the 365 days keep running.
Vivlio retrieves the hospital and specialist records for a case management agency, under the release the applicant signed at application, and organizes them the way the level-of-care form reads: diagnoses, medications, hospital stays, functional findings. The form reaches the physician with what it asks about already attached. For the other states’ instruments, see the level-of-care form, state by state; for Georgia’s programs one by one, see Georgia’s Medicaid waivers and the records each needs.
